TNFa inhibition in anti-Ro/SSA positive patients with rheumatoid arthritis: clinical and immunological effects

Objective: to analyse efficacy and safety of anti-TNFa treatment in 17 patients with rheumatoid arthritis (AR) and anti- Ro antibodies, in order to detect difference in clinical and immunological response. Methods: 322 patients, affected by RA and treated with anti-TNFa drugs, were considered, searching every 6-12 months ANA, anti-dsDNA and anti-ENA antibodies. Seventeen were anti-Ro positive and 305 anti-Ro negative before starting treatment. Results: anti-Ro positive subjects showed active arthritis at baseline (mean DAS: 5), with frequent extra-articular features, such as ocular and oral sicca symptoms. They showed rapid and stable improvement during the treatment, without significant difference compared to anti-Ro negative group. A good clinical Eular response was shown in 46% of anti-Ro negative subjects, steady stable during time. On the contrary, fewer anti-Ro positive patients seem to be “good” responders. RA remission (DAS <1,6) was achieved in 9-25% of anti-Ro positive and 21-29% of anti-Ro negative, without significant difference. Antinuclear antibodies tend to increase in both groups, during the time. Anti-DNA increased to 40% of anti-Ro positive sera since 6th month, while they slightly increased in first 12 months in anti-Ro negative ones, then decreased to baseline value. No differences were shown about the frequency and reasons of anti- TNFa withdrawal, except for cutaneous lupus-like disease, more detected in anti-Ro positive group. Conclusions: anti-TNFa drugs are effective in anti-Ro positive RA as well as other RA patients. Anti-DNA positivity and lupus-like disease were more frequently observed in anti-Ro positive group.